Applicants with undocumented immigration status, may utilize a statement signed by case manager or eligibility worker and applicant, stating he/she does not have a valid state ID due to undocumented immigration status and does not possess documents that could otherwise be used to verify residency

Bank statements (savings or checking) from the last 3 months with the bank’s name/logo

If employed, pay stubs from the last 3 months

If not available, Signed employer statement with dates, position , phone number and salary

Unemployment income

Rental income for the last 3 months

Retirement statements for the last 3 months

A recent TPQY/SEQY printout from Social Security

Letter of award from Social Security (SSI/SSDI), Food Stamps, TANF, or VA

If no income/unemployed, signed support letter from person providing assistance stating how applicant receives food, clothing, shelter, monthly allowance amount and how long assistance is expected to last

In isolated cases for clients who have an undocumented immigration status, a statement signed by case manager or eligibility worker and client, stating client does not hold a valid INS work permit (authorization), and staff verified that client is not receiving any federal, state or county entitlements.

Health Insurance Coverage*Having Health Insurance Does Not Automatically Exclude Applicant From Part A Eligibility